Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-2035, Submission # Submission-2019-2130, UID # 25733
Status: Compliance Inspection Accepted
 

System Status

System status on date: 12/16/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
25032213300029260 190TH ST N, CITY OF FOREST LAKE9260190THSTNFOREST LAKECITY OF FOREST LAKE55025RIES SARAH A & ANDREW I BENTLEY1977
Owner's representative:
Name:
Ryan Lashinski
Email:
rlashinski@gmail.com

Impact on Public Health

System discharges sewage to
the ground surface:
No System discharges sewage to
drain tile or surface waters:
No System causes sewage backup
into dwelling or establishment:
No
Verification method(s):
Searched for surface outlet
Searched for seeping in yard/backup into home

Tank Integrity

System consists of seepage pit,
cesspool, drywell, or leaching pit:
No
Sewage tank(s) leak below their
designed operating depth:
No
Verification method(s):
Probed tank(s) bottom
Examined empty (pumped) tank(s)

Other Compliance Conditions

Maintenance hole covers are damaged, cracked,
unsecured, or appear to be structurally unsound:
No
Other issues (electrical hazards, etc.) to
immediately and adversely impact public
health or safety:
No
System is non protective of groundwater for other
conditions as determined by the inspector:
No

Date of Install

Date of install known: No

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
Drainfield has at least a three-foot vertical separation
distance from periodically saturated soil or bedrock.:
Yes
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
Yes
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
Two previous verifications (Attach boring logs)
A. Bottom of distribution media: 0 Decimal Feet
B. Periodically saturated soil/bedrock: 3 Decimal Feet
C. System separation: 3 Decimal Feet
D. Required compliance separation: 3 Decimal Feet

Operating Permit and Nitrogen BMP

Is system operating under an Operating Permit: No
Is the system required to employ Nitrogen BMP: No

Comments and File Attachments

Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Lashinski SepticL65763-434-39151244 Crosstown Blvd NE Ham Lake, MN 55304NoNoNoNoNo
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: rlashinski@gmail.com

Terms

Certification
  • By submitting this form I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the future
    system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate
    maintenance, or future water usage

Invoice #5116 (12/16/2019)

Charge Cost Quantity Total
Non-Taxable
added 12/16/2019 3:16 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 12/16/2019$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantRyan E. Lashinski - 12/16/2019 3:17 PM
b6cc5b42fc93d1ea64cf1fe341534b9e
2a70ab1e27c458df75204740b0bb5a19
 
#1 Compliance Inspection AcceptedDenise Lange - 12/17/2019 4:11 PM
7b6e8476d39ecbf87853dd4a2771c527
c70a422bc9138b6a9e332d8d15de3caa
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    File(s):
      Compliance Letter Type: Who's signature should be on the letter? Permit number to reference in "No Replace" letter:
      Was the letter sent? Compliant/Non-Compliant:
      Certificate of Compliance:
        Letter of Non-Compliance:
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